Intensive Exposure and Response Prevention for Adolescent Body Dysmorphic Disorder With Comorbid Obsessive–Compulsive Disorder and Major Depressive Disorder

Abstract

Body dysmorphic disorder (BDD) primarily onsets during adolescence, and symptoms typically worsen when left untreated. Although use of cognitive-behavioral therapy (CBT) has established efficacy for adults with BDD, there is limited research and few case studies to suggest the same for adolescents and children. The present case describes the implementation of intensive (daily) treatment for Erin (pseudonym), a 17-year-old Caucasian female with primary BDD, as well as comorbid obsessive–compulsive disorder (OCD) and major depressive disorder (MDD), who was initially nonresponsive to outpatient supportive psychotherapy and pharmacotherapy. Treatment consisted of exposure and response prevention (ERP), concurrent with behavioral activation (BA). At discharge, Erin’s total score on the Children’s Yale–Brown Obsessive Compulsive Scale–Self-Report version (CY-BOCS-SR) decreased from 32 (extreme severity) at pretreatment to 11 (mild severity), as well as demonstrating improvement on other self-report measures.

Despite significant reductions in ritual engagement, Erin’s symptoms never fully remitted. Based on telephone contact with her mother, Erin discontinued ERP upon returning home, where treatment gains were not maintained and symptoms returned to baseline severity. Thus, this case study demonstrates the effectiveness of intensive ERP for adolescent BDD, as well as demonstrating the lack of gain durability associated with withdrawing early from treatment. Furthermore, this case demonstrates that withdrawal from ERP prior to complete remission may lead to a resurgence of symptoms, thus making previous progress obsolete.